VIENNA - While a 10-year review at a Netherlands breast cancer screening program discovered only three medicolegal cases stemming from screening mammography, it also identified opportunities for improvement, according to a study presented Monday at the European Congress of Radiology (ECR).
Despite the small number of claims, the researchers discovered more than 20% of screening-detected cancers could have been referred for follow-up at the patients' previous screening mammogram. Also, nearly one-quarter of interval cancers were missed on the patients' latest screening study.
Most studies in the literature on medicolegal issues from screening mammography come from the U.S., where the failure or delay in breast cancer diagnosis is the most prevalent reason for medical malpractice claims, said presenting author Dr. Wikkie Setz-Pels of Catharina Hospital in Eindhoven. Average payments for malpractice claims related to breast cancer also are the second most expensive in the U.S.
After being unable to find any data in European journals on this topic, the researchers sought to determine the type and frequency of medicolegal claims at a Dutch breast cancer screening program.
The study team reviewed the records of all 80,019 women who had participated in the screening mammography in the southern breast screening region of the Netherlands between January 1997 and July 2007. In the study period, 301,139 screening mammograms were performed.
Women ages 50 to 75 receive biennial screening studies in the Dutch mammography screening program. Patients are referred following independent double reading, Setz-Pels said.
The study team gathered all medicolegal claims that had been recorded in the central screening department within three years following the patients' last screening mammography study. Biopsy results and surgery reports of all referred women were collected during a two-year follow-up period.
Blinded to each other's findings, two certified and experienced screening radiologists independently reviewed all screening mammograms of those who had screening-detected cancers, and those who had interval cancers. They determined if the cancer was missed on the latest mammogram -- and if it showed a minimal sign -- or if it was occult.
Of the three medicolegal claims that were reported, all concerned financial compensation from failed diagnosis of interval cancers. Two verdicts still have to be finalized, while one claim has been rejected, she said.
In 261 (20.8%) of the 1,254 screening-detected cancers, the cancers appeared to be missed on a previous screening study, Setz-Pels said. No claims were seen in this group, however.
In interval cancers, 139 (23.6%) of the 588 were missed at the latest screening study, she said. The three medicolegal claims came from this category.
The researchers also investigated other possible reasons for patient complaints. They found that 234 (10.7%) of 2,183 cases received a false-positive referral for surgical biopsy. No medicolegal claims originated from this group of patients.
The study team also found a delay in clinical workup in 6.5% of screening-detected cancers. Of these, 51 (62.2%) were delayed from three to 12 months, 19 (23.2%) were delayed from 12 to 24 months, and 12 (14.6%) were delayed more than two years. No claims originated from this group, either.
The researchers also calculated how many women contacted the screening organization because of complaints or questions. Only 16 patients did so in the 10-year study period, she said. This included six patients with screening-detected cancer and 10 patients with interval cancers.
"All of these women had contact with the coordinating screening radiologist, and no claims were reported from these women," she said.
